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Flashcards in Shoulder Deck (39):
1

Neer

Based on cadaver dissection

2

Neer- impingement occurs where?

Repeated impingement of the cuff and numeral head and traction on the coracoacromial ligament

3

Neer- which muscle tendon is most frequently involved?

Supraspinatus tendon

4

Neer- what is the critical zone?

Elevation of the arm at 70 degrees where the critical zone pass under the CA lig and anterior process of acromion

5

Neer- what the dx usually?

Degenerative tendinitis

6

What is the Hawkins-Kennedy impingement test testing?

Glenohumeral impingement or supraspinatus/paratenonitis

7

What is the procedure for the Hawkins test?

Pt seated or standing, arm resting at side
PT passively flexes shoulder to 90 degrees, flex elbow to 90 degrees and internally rotate shoulder

8

What does the compression test (O’Brien’s) test?

Detects SLAP lesion

9

Whaat is the procedure for the compression test?

Pt seated/standing with arm held at 90 degrees flexion and full elbow extension
Arm is horizontally adducted 10-15 degrees and medically rotated so thumb points downward
PT applies downward force to the arm
Arm is laterally rotates so palms up and PT applies downward force

10

Why would someone present with a positive finding with the thumbs down position versus palms up? (Compression test)

Compressing the space, make sure to differentiate the difference between AC and labral pathology

11

Droparm test

Test for rotator cuff tear

12

What’s a positive finding for drop arm?

Pt unable to slowly lower, ratchety movement, severe pain

13

Empty can test

Test for supraspinatus/muscle neuropathy of nerve

14

What are the pathologies of a rotator cuff tear?

Intrinsic cuff problem
Supraspinatus weakens and degenerates with age
Fatigues with use in athletes
Overpowering by deltoid causes superior migration of numeral head
Impingement with secondary bony changes

15

What are some causes of rotator cuff tears?

Trauma- shoulder dislocation, prox numeral fx, scapular fx
Instability (labral tears)

16

What is the progression for a rotator cuff tear?

Starts at the critical zone ->supraspinatus ->progress with further tension -> infraspinatus -> subscap

17

What population of people are more likely/at risk to tear their RC

>40 yrs and sedentary people doing light work

18

What is anterior traumatic instability

Instability caused by hyperabduction-external rotatory forces

19

What is the result of anterior traumatic instability?

Capsulolabral avulsion at the 3-6 o’clock position on the glenoid

20

Anterior traumatic instability- high or low rate of recurrence?

High (94%) if youre <20

21

What is a bankart lesion?

Labrum and capsule avulsed from glenoid

Periosteum torn

Labral complex floats freely

*associated with dislocation, bony lesion*

22

What are the stages of impingement?

I -> edema and hemorrhage
II -> fibrosis & tendinitis
III -> AC Spur and RC tear

23

What are some pain management tx?

NSAIDS, is, iontophoresis, subacromial injections

Pain, motion, strength, scapular control, strength

24

What is the operative tx of impingement?

Debride subacromial bursa

Remove impinging structures (osteophytes, coracoacromial ligament)

Early post op strengthening

Open vs arthroscopic

25

WHat are some benefits of arthro decompression?

decrease deltoid morbidity, lower narcotic requirements, lower hospital costs, earlier return of ROM, directly assess jt.

26

What’s the post op course?

Depends on quality of tissue and strength of repair
Begin early PROM
Scap stabilizer strength
1st 6 wks- PROM
2nd 6 wks- resisted iso
After 3 mo- healed

27

What is a SLAP tear?

Associated with biceps rupture, mainly a labral tear.

28

What is the apprehension test (crank test)?

Determine integrity of glenoid labrum & anterior inferior capsule

Pt Abd & ER
Feels like it may slip

29

What is the fulcrum test?

Determine anterior instability

Pt supine do 90/90
+if increased motion/local pain

30

What accounts for 4% of GH dislocations?

Posterior, also a recurrent post sublux

31

What does someone with a posterior dislocation have pain with?

Flexion, add, IR

32

What are some tests to test for posterior dislocations?

Jerk test

Load & shift test

Kim’s test

33

What are the grades of instability?

0 no translation
1 (mild)= numeral head moves slightly up face of glenoid 0-1 cm translation
2 (mod)= numeral head rides up but not over the rim (1-2cm)
3 (severe)= humeral head rides over glenoid rim

Reduced when stress is removed

34

WHat is adhesive capsulitis?

Frozen shoulder
Most limited in shoulder ABd & ER

35

What are common comorbidities of frozen shoulder?

DM and hypothyroidism

36

What is the tx for frozen shoulder?

Conservative
6 mo
Reduce pain (NSAIDS, injections)
Aggressive ROM
Strengthen after motion returned

37

Post op procedure for frozen shoulder?

Aggressive ROM
Pain pump (scalene block)
Movement

38

What are the indications for surgery post fx?

Absolute:
-articulate involvement (2mm+)
-sig. displacement
-fx-dislocation
-neurovascular injurty
-open fx

Relative:
Age, activity lvl, hand dominance

39

Therapy for post fx?

PROM until tuberosities heal

30-45 deg arc for 3-4 wks
90 deg for wk 4-6
Strength in wk 6-12